Download We see the individual, not just the addiction

Stockholm Centre for Dependency Disorders
We see the individual, not just the addiction
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It is estimated that in Sweden there are:
330,000 people with alcohol dependence
80,000 with drug dependence, of which 29,000 are heavy users
65,000 with an addiction to pharmaceutical drugs.
Source: Missbruksutredningen (Abuse Inquiry)
(SOU 2011:35)
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Treatment for substance use
disorders helps people and
saves lives
The Stockholm Centre for Dependency Disorders
is the County Council´s clinic for specialized care
for substance use disorders. With a high level
of medical expertise and the broadest range of
interventions in the country, we offer treatment
and support to individuals with problems related
to alcohol, street drugs or pharmaceutical drugs.
As Sweden´s largest treatment provider for
substance use disorders, we are in a unique
position to treat and help patients with harmful
use, abuse and dependence. With the right
treatment and a holistic view of the individual,
we support our patients and their families
towards improved quality of life. We see the
individual – not just the addiction.
Our staff extends a warm welcome!
Johan Franck
Head of Clinic
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Substance dependence is a disease
and must be treated as such
Dependence is an acquired, chronic disorder, which in the
vast majority of cases is treatable. Considering the knowledge
available today, dependence should be seen primarily as a health
issue rather than a social issue.
When a person uses an addictive substance, the brain´s reward
system is activated, releasing dopamine, which provides a feeling
of euphoria. However, long-term abuse leads to a change in
the brain and a dependence begins. Substance dependence is
characterized by repeated drug seeking behaviour, compulsive
drug use and losing of control over intake. In the long-term, this
leads to an emotionally negative state with anxiety, irritability,
suicidal thoughts, sleep disorders and cravings, in which the
individual´s will or motivation is to some extent out of the
picture. The reward system is ”kidnapped”, so to speak.
There is no sure way of identifying ”risk free” use; this relies
on many different factors. Different people have different
propensity of developing dependence. The time required to
develop dependence also varies with individual factors and type
of drug.
Harmful use, abuse and dependence. There are differences
between harmful use, abuse and dependence. With regard to
alcohol, for example, the diagnosis is not based primarily on
how much a person drinks; it also takes into account the effect
on the individual and his or her environment. Harmful use can
most often be stopped through the individual reaching a clear
understanding of the negative effects. Abuse and dependence
are much more serious and difficult to break out of.
Harmful alcohol use is when a person drinks so much, and in
such a way, that there is a risk of ill health and social problems
if they continue to drink at that level. The amount of alcohol
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The most common
addictive substances
are nicotine, alcohol,
cannabis, central nervous
system stimulants, opiates,
hallucinogens and various
pharmaceuticals drugs.
that the body can reasonably handle is
different from person to person. The
borderline for harmful use is considered
to be at 15 standard drinks per week
for men and 9 standard drinks per week
for women. Another warning factor
is ”binge drinking”, i.e., more than 5
standard drinks on one occasion, at a
frequency of two times per month or
more. In general, a consumption rate
of more than 60 grams of pure alcohol
per week, over a period of 6 weeks or
more, is said to have negative effects on
health.
MEASURES OF ALCOHOL CONSUMPTION
1 standard drink = 12 g alcohol or:
Abuse is the repeated use of addictive
substances in a way that leads to
recurring social and interpersonal
problems. One example of this is to
subject oneself and others to danger
through drink driving, taking sick leave
or turning up late to work due to, e.g.,
a hangover, or destroying a relationship
because alcohol or drugs come first.
•
Dependence means that the brain has
been affected by alcohol or drugs to
such an extent that it undergoes major
changes. At this point, individual will
power alone is no longer enough to
control the intake; the alcohol or drugs
control the dependent person´s life.
Symptoms include increased tolerance,
abstinence, loss of control and the
individual´s thoughts revolving primarily
around the substance.
•••••
one glass of wine
one medium-strong beer (50 cl)
one small strong beer
one small cocktail/mixer (4 cl spirits)
•••
One large strong beer = 1.5 - 3 standard drinks depending
on the alcohol content (%)
One bottle of wine = 5 standard drinks
•••••••••
A half bottle (37 cl) of spirits = 9 standard drinks
••••••••••••••••••
One bottle of spirits = 18 standard drinks
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The mortality rate due to drug addiction
is on the increase. Each year, around
400 persons die as a result of drug
addiction in Sweden.
10 % of ninth-grade pupils (15-16 years
old) have tried drugs
Around 2 % of all healthy adults are
addicted to pharmaceuticals
Around 2 % of Swedish people have
problems related to gambling or have
a gambling addiction (approximately
125,000 people)
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Addiction treatment takes a long time but produces results
For us at the Stockholm Centre for
Dependency Disorders, specialized medical
expertise is as natural and central as
empathy and respect for the patients and
their life situation. Working in dependency
disorder care is about helping the patients
change their lives, on the basis of their own
capabilities.
Harmful use can often be stopped by
identifying habits and behaviours, and by
providing relevant information. If harmful
use is identified early on, it is easier to
provide the right help and support in a timely
manner, so that the patients can change their
habits. However, patients who have reached
the abuse or dependence stage often need
additional help.
New strategies lead the way
The treatment of abuse and dependence is
a long process. The treatment provider and
the patient work together to change the
patient´s dysfunctional strategies - i.e., the
abuse - and find new functional strategies for
handling stress via means other than alcohol
or drugs. These strategies include identifying
risk situations and practicing new social skills.
The treatment includes increasing the
motivation to change and to develop
new behaviours, but also to understand
underlying factors. It is a matter of finding
the patient´s strengths and highlighting the
positive. In many cases, involving the family
can be greatly beneficial.
When the patient breaks free of their
addiction, they receive help to ease their
withdrawal symptoms through the use of
non-addictive pharmaceuticals. A distinction
is made between detoxification, which takes
place in 24-hour care, and maintenance
therapy, which is handled via outpatient care.
Inquiry and care plan as the basis
We start the treatments by identifying the
addiction. During the first visit, the patient
meets a nurse or a psychologist as a rule,
for discussion and examination. Following
this, an individual treatment programme is
formulated. All treatment follows a care plan.
As a basis for the care plan, we conduct a
careful inquiry and assessment in accordance
with research-based treatment methods.
Part of the initial assessments are tests in the
form of AUDIT, DUDIT and other tests, where
health care personnel can help patients to
test their alcohol and drug habits.
Recurring elements of the treatment are
usually individual talks, medical treatment
and relapse prevention. Where required, the
patient is also offered psychotherapy.
Swedish men drink twice as much as
Swedish women
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See the individual, not just the addiction
The Stockholm Centre for Dependency Disorders is Sweden´s largest
clinic for treatment of substance use disorders, and is commissioned
to conduct specialized care for all of Stockholm county. Based on our
motivation to increase patients´ quality of life, as well as that of their
families, we offer evidence-based treatment throughout the healthcare
chain. Our task includes large sections of the outpatient dependency
disorder care and 24-hour care, as well as emergency care for those
of the county´s patients who have substance use problems. The
main target groups are people with alcohol, drug or pharmaceutical
dependence. Many use several drugs, and many have other psychiatric
or medical problems, often as a direct result of their addiction.
Between 5,000 and 7,000 Swedes die from alcohol-related
illnesses or injuries each year
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A broad range of care
services and continuity in
the healthcare chain
We operate in some 70 locations across the
county and on three levels: local outpatient
care, emergency- and 24-hour care, as
well as highly-specialized programmes.
Our intention is to be close to the patient,
to have a high level of availability and to
provide different types of care to patients
with different needs, in the way that suits
them best. As patient needs change, we
are constantly evaluating and developing
our range of services and our treatment
methods. With the breadth we offer, we
can integrate the care throughout the
chain, to the greatest extent possible,
and maintain a sense of continuity for the
patient.
To be able to provide patients with
a cohesive and functioning care, our
operations also have close cooperation
with psychiatric care, primary healthcare,
social services and the Swedish Prison and
Probation Service – a cooperation which we
are constantly developing and improving.
Local operations close to users
Our clinics are located close to the users,
out in the municipalities and city districts.
They are most often integrated with
social services and we work together with
psychiatric care and primary healthcare.
The clinics act as a qualified resource
for people with alcohol, pharmaceutical
and drug dependencies. We also have
dedicated local clinics for young people.
Outpatient clinics can be applied to directly, but the
patient may also choose to go via their occupational
physician or medical centre. The patient may choose
the outpatient clinic best suited for him or her. If the
patient needs to be admitted for detoxification, both
emergency clinics and outpatient clinics can refer the
patient to one of our departments for 24-hour care.
Emergency care, 24 hours a day, 365 days a year
Patients who require emergency care for substance
related problems, who need to sober up, receive a
detoxification programme or be admitted, come to
Beroendeakuten Stockholm (BAS), a substance abuserelated emergency department, to stay in one of our
wards. BAS is located at S:t Görans Hospital and is
open 24 hours, every day of the year. After receiving
emergency care, patients can go to the outpatient
clinic that best suits them.
For patients with addiction to pharmaceutical drugs
(e. g. bensodiazepines or pain killers), there is a specific
ward open on weekdays at Sabbatsberg Hospital.
Maria Ungdom, which is targeted at young people up
to 20 years of age, has a 24-hour emergency clinic and
specialized outpatient care.
Emergency and 24-hour care is primarily voluntary, but
in some cases care is implemented in accordance with
the compulsory care legislation (see the Compulsory
Mental Care Act - LPT - and the Forensic Mental Care
Act - LRV).
Highly-specialized programmes for different
patient groups
The Stockholm Centre for Dependency Disorders also
offers care with a high level of medical specialization.
Patients can apply to the highly specialized
programmes directly or through their local dependency
clinic, though in certain cases a referral is required.
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Long-term medication-assisted care. Highly specialized medication-assisted care
for patients with an opiate addiction is available in the Methadone Department,
where we offer evidence-based rehabilitation for opiate dependent patients, through
methadone or buprenorphine treatment. Patients are referred from local outpatient
clinics, the Swedish Prison and Probation Service, the non-custodial care system and
the municipal infection clinics. A unique aspect is that patients can also apply for
treatment if they are in prison.
In addition to their addiction, patients often have poor psychological and physical
health. Complex care needs, and long-term treatment relationships place high
demands on treatment providers. With long-term rehabilitation we help the patients
to break free of their dependency, stabilize their social situation and achieve improved
physical and psychological health.
Maria Ungdom never sleeps. Maria Ungdom is specialized in helping young persons
and their families with problems related to alcohol, drugs and psychological ill health
related to dependency. Young persons up to 20 years of age are welcome. These
activities are operated in close cooperation with the social services, the police and the
emergency medical services.
At the emergency clinic, which is open 24 hours a day, we receive young persons under
the influence of alcohol or drugs, in order to help them to sober up and stabilize.
We also carry out planned 24-hour care for young persons who require a longer
programme of detoxification, support and investigation. Maria Ungdom also offers
telephone advice to the public 24 hours a day, to youth clinics with specific knowledge
on young people in risk environments, and to outpatient clinics throughout the
county; known as the ”MiniMarias”.
Leading treatment of patients with addiction to prescription drugs. The
Stockholm Centre for Dependency Disorders is a leader in the treatment of patients
with an addiction to pharmaceutical drugs. The programme offers outpatient care and
a ward with 24-hour care open on weekdays. Treatment components include phasing
out prescription drugs, and support for family members. Interventions are coordinated
with psychiatric care, primary healthcare, social services, occupational healthcare and
the Swedish Social Insurance Agency.
Women´s clinics. We have a number of clinics specifically for women, including
the EWA clinic for women with alcohol-related problems who have children under
the age of 18. Rosenlund´s prenatal care team offers specialist prenatal care for
prospective parents with harmful use, abuse and/or behaviour-related problems, and
for pregnant women undergoing medication-assisted care. We also offer councelling
and measures to prevent STI/HIV.
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With the aim of reaching more patient groups and meeting a wider variety
of care needs, we also have several other specialized programmes, including:
HBT clinic for homosexual, bisexual and transgender persons with harmful
use, abuse and dependence.
Konsultmottagningen I66, a consultation clinic with highly specialized
outpatient care and consultation for patients with substance use problems
and concurrent somatic disease.
Livsstilsmottagningen [Lifestyle Clinic] for young adults aged 18-30 whose
lifestyle and health are being negatively affected by alcohol or drugs.
Magnus Huss-mottagningen [the Magnus Huss Clinic], which specializes
in research and development of new treatment methods for persons with
alcohol or drug-related problems.
Mångbesökarteamet [the Multi Visitor Team], who help patients who
repeatedly seek emergency clinic treatment and who have difficulties
accessing regular outpatient treatment.
Neuropsykiatriska mottagningen [the Neuropsychiatric Clinic] is a
resource for all of Stockholm Centre for Dependency Disorders, carrying
out assessments and pharmacological ‘second opinion´ on neuropsychiatric
functional impairments.
In Stockholm, there are:
approx. 80,000 people
with an alcohol addiction
approx. 15,000 people
with a drug addiction
Riddargatan 1, which receives patients with alcohol-related problems but an
otherwise functional social life.
ITOK (Integrated Team for opiate dependent Prison and Probation Service
clients), SMADIT (Cooperation against alcohol and drugs in traffic),
Stadshagsmottagningen [Stadshagen clinic] and local drink-driving clinics
for persons offered care as a result of substance abuse-related crime.
Smärtteamen [two pain clinics] for patients who have become dependent on
analgesics, owing to primary pain-related problems.
Spelberoendebehandling [Gambling Addiction Treatment] for persons who
have developed a destructive addictive behaviour with regard to gambling.
Support for the family
The Stockholm Centre for Dependency Disorders also offers programmes
with information and training for patients´ families. These may be husbands/
wives/partners with children, but also parents, siblings or close friends. Our
programme Anhörigstyrkan [support for relatives] helps the family gain a
better understanding of how addictive disorders work and how they affect
the individual. As with all healthcare, we are also obliged to contact social
services if a patient has children living at home, who are at risk of ill health as
a result of their parent´s addiction, or that of a relative.
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A high level of competence
and high standards result
in good care.
Knowledgeable and committed staff
The Stockholm
Centre for Dependency
Disorders in figures
Eight sections, with a total of 75
units and clinics
A total of 680 employees: 250
nurses, 100 doctors of which
80 are specialist doctors and
20 residents, 180 nurses in
psychiatric care, 35 psychologists,
40 medical secretaries, and
midwives, welfare officers,
psychotherapists, behaviourists,
occupational therapists, R&D
personnel and administrators.
Healthcare production in average
figures in 2011:
patients (individuals): 19,000
visits to outpatients programmes:
277,000
overnight stays: 24,000
emergency unit visits, 24-hour
care: 12,000
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At our clinics there are specialist doctors
in the areas of addiction medicine and
psychiatry, nurses with specialist training ,
and psychologists with special competence
in neuropsychological assessment. The first
person our patients meet is most often one of
our medical secretaries or receptionists, who
assist with practical matters.
Case managers are often available at the
clinic. They work with patients who have
special needs, to coordinate treatment
and support. At some clinics we also have
occupational therapists who can help our
patients to attain a functioning daily life.
The Stockholm Centre for Dependency
Disorders is run by an Operations Manager,
with a central administration. Each
operational area/department (geographical
and specialized) is run by a department head
and a department administrator.
Education and research
The Stockholm Centre for Dependency
Disorders is a university clinic which conducts
teaching and research. In these areas,
we cooperate with Karolinska Institutet
through the Stockholm Centre for Psychiatric
Research and Education. We also have clinical
education facilities for healthcare and medical
students, including internships and residencies
for doctors, and clinical training of nurses and
psychologists.
Internally, we conduct professional education
and training in order to ensure that our
employees have the expertise and develop
the required expertise. We continuously strive to enhance
our clinical skills and the quality of our programmes, based on
available scientific evidence.
Patients and relatives are offered courses to enhance their
participation in the programmes.
Quality, environment and patient safety
In 2009, the Stockholm Centre for Dependency Disorders was
the first health care clinic in Stockholm County to be quality
certified in accordance with the international standard SSEN ISO 9001:2008. In addition, we have for many years been
environment certified in accordance with SS-EN ISO 14001:2004.
We work actively on patient safety, with an action plan that is
known and accessible to all personnel. We have well-developed
networks, both inside and outside of the clinic, which provide
good opportunities for the exchange of experiences and
constant improvement.
Between 1996 and 2010 we have seen
a 14 % increase in alcohol consumption.
Contributing factors
Saturday openings at Systembolaget, increased sales of bag-in-box
drinks, increase in alcohol imports, liberal attitude towards alcohol.
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Want to know more?
More information on the Stockholm Centre for
Dependency Disorders can be found on our website,
www.beroendecentrum.se. You can also find a PDF
version of this folder – both in Swedish and in English –
on the website.
Some of our specialized programmes also have
separate websites: beroendemottagningenhbt.
se, livsstilsmottagningen.se, mariaungdom.nu and
riddargatan1.se.
Up-to-date contact details for our departments and
clinics can be found on www.vardguiden.se. You
can also order our contact guide (in Swedish) for
associated healthcare and partners, Hitta Rätt. E-mail
[email protected], stating how many copies
you would like and your postal address.
Please use the same e-mail address to order printed
copies of this folder, in Swedish or in English.
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Mars 201
t
t
ä
Juni 2011
Hitta r
September
2011
Hitta
rätt
Hitta rätt
vår
talog för
Kontaktka etspar tner
arb
och sam
dgrannar
Kontaktkatalog för vårdgrannar
och samarbetspartner
Kontaktkatalog för vårdgrannar
och samarbetspartner
1
1
1
www.beroendecentrum.se
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How to access the Stockholm Centre for Dependency
Disorders
Patients can apply to our emergency care and our local outpatient care directly, or via primary
healthcare, occupational healthcare or the Swedish Prison and Probation Service. Most of our
specialist units also receive first-time patients directly, but for some of them a referral is required, or
prior admission as a patient to the Stockholm Centre for Dependency Disorders.
Emergency
care
Patient
Outpatient
care
24-hour care
Referral
Highlyspecialized
programmes
Referral from associated
care such as the Swedish
Prison and Probation
Service, primary healthcare,
psychiatric care, social services
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GRACEMILL stockholm 2012
www.beroendecentrum.se
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